Botulinum-A intramuscular injection in an orthopaedic paediatric patient cohort: service restructure analysis.

Botulinum intramuscular injections are increasingly being used in the management of hypertonic musculature. Historically, injections were administered under general anaesthesia (GA), which has service and economic implications. Our delivery changed to outpatient conscious injections to improve service efficiency. A retrospective analysis of all patient injections from January 2010 to December 2015 analysed cost-benefit and efficiency of service remodelling. 472 patients were administered injections, 298 in theatre under GA and 174 without GA. In 2010, 97 of 102 cases were performed under GA (45 theatre-hours), decreasing to 18 of 68 cases in 2015 (8.4 theatre-hours). The mean hospital stay decreased from 410 to 135 min. The reduction in theatre use and the requirement for a postanaesthetic bed led to significant savings per case. Service remodelling showed successful cost saving and reduced in-hospital stay.